Anorexia. Harsh, taboo, sends a shiver down your spine. Parents shudder and
silently pride themselves on their teenager’s health, whilst the teenager whispers
with their friends about the suspiciously skinny sick girl. She works head-down
every lesson, though is never really there – she’s locked inside her mind, you see, in
a battle for her mind itself.
At the word anorexia, you likely thought of a Cassie Ainsworth dreamer – slim,
teenage girl, picture perfect family hiding self-absorbed parents. True, the major
demographic of anorexics are female, specifically teenagers, but this gets conflated
into the idea that only teenage girls can be anorexic – it could just as easily afflict
the 26 year old gym bro, or your local librarian. Many could argue that the 2000s
starving skinny aesthetic and ‘thin-spo’ Tumblr enforced this belief, but then the
question must be asked ‘why do we still not see the truth?’. The answer is simple –
fear. Adults tiptoe around the word, flag it up on school systems, give assemblies on
healthy eating with pictures of sallow, malnourished girls in the background. The
gymnasts and dancers face anorexic accusations, whilst the bullies hurl them at
their too-skinny peers. But, all the while, not one person truly understands the
parasite they speak of – if you do, it’s too late.
To understand the truth of anorexia, you have to have survived the deadliest mental
illness. No amount of sobbing and gesticulating, shouting and pleading can convey
its horror to a parent, a friend, a therapist. There’s no way to relate the feeling of
thousands of cockroaches entering your stomach at the sight of your favourite food,
of the unsuppressable swell of disgust and guilt after dinner. You can describe a
surrealist world – a bone-cold world stripped of flavour and colour, body shape
fluctuating every minute, a salty taste left mingling in the air. All you’ll get are
wide-eyed stares and hushed arguments, the threat of hospital floating towards you.
But the truly terrifying part is not the blackness encroaching upon the corners of
your vision, nor the constant muffling cloud lying over your brain – the true terror
is the comfort you feel in that place, walking the liminality between life and death.
Like any good parasite, anorexia hides itself. In the dark crevices of your mind it
shelters, feeding on your suffering, a sadistic foe that can never quite be
vanquished. It’s more than any old disease – it ekes out treasured moments of
happiness, letting you bask in its glory as it steals more of your being. Once it has
wormed its way into your mind, fuelled by offhand comments and dwindling
dopamine, it constructs a mirror – you and it vs the world. As your concerned
mother sidles towards you, inconspicuous Mars bar outstretched, the world
.flips
Now, your mother walks towards you with a suspicious glint in her eye, the
chocolate wrapper crinkling aggressively in his hand. You lean back behind the
mirror, into the comfort of your roommate, by now as familiar as the Friday family
movie-nights you used to love. Soon the comfort turns into oblivion – unending cold
and exhaustion go unnoticed in the haze of your dreams, pushing through despair
and hopelessness, until finally… you break.
It’s different for everyone – pleas from family, the promise of a better future, maybe
a weekend hiatus to A&E. For some, it’s the threat of life continuing past tomorrow,
another failed day. For another 20%, they don’t get off at the breaking point – they
plunge so deep that resuscitation efforts fail, mournful corpses drifting off along a
boulevard of broken dreams. But for those valiant prisoners, who still have that
final drop of strength, they strike against the mirror so hard as to cleave off the
tiniest chink, a sole ray of hope peaking through. What follows is the hardest
journey of their life – the road to recovery.
The indignity begins immediately. Tests, investigations, tell-tale trail of red dots
from the hourly blood monitoring. One of the most dangerous secrets of anorexia is
refeeding syndrome, a life-threatening complication of nourishment after an
extended or severe period of malnutrition. The body must slow down its metabolism
to conserve energy during undernutrition, even turning to its own fat and muscle
for fuel (this being the culprit of the permanent brain fog). However, once food
returns, the body jumps in delight and returns to its everyday carbohydrate
metabolism – in its delight, it overlooks the caches of micronutrients stolen by
anorexia. When the long-awaited bounty is finally eaten, your cells demand
electrolytes to metabolise the food, causing a severe shift in body chemistry. This
can result in nausea, swallowing problems and muscle weakness, to the more severe
kidney dysfunction, seizures, coma and cardiac arrest. What a lovely welcome back
to the land of the living!
Unfortunately for our escapee, they’ve still got a long slog through parole before the
impossible can be reached – freedom. Bodies lose muscle mass before fat in weight
loss (unless tightly controlled), and severe weight loss breaks down the big guns.
For many, heart muscles are greatly weakened, resulting in low heart rate and
arrhythmias – a little-known result of these is an ominous purple flush to feet when
stationary, and blue-tinged fingers at most times. To rectify this, and the constant
fatigue, gastroparesis etc., they must do that which scares them most – gain weight.
As a cherry on top, it must be fat, as the body prioritises protecting vital organs
above juvenile concerns like self-esteem. This often results in a much-needed
central adipose body type (displayed by pot-belly beer drinkers), sending the sufferer
into a spiral of regret. To push through requires sheer willpower, and it is VITAL to
do so. After a period of time, the body will redistribute weight more evenly,
confident that danger has passed – fighting the weight only prolongs your suffering
and risk of osteoporosis (SERIOUSLY UNWANTED BONE CONDITION).
But recovery is not simply gaining weight – it’s slamming against the mirror with
the force of tear-drenched nights and missed opportunities, silent screams in the
changing rooms.
It’s breaking the surface of the muffled sea into a world of chaos and colour, sound
and beauty.
It’s the ebb and flow of the darkness, never quite disappearing but overwhelmed by
possibility and experience, laughter and arguments, of a life almost extinguished.
It’s truly you.
Sources:
● Cleveland Clinic – Refeeding Syndrome
https://my.clevelandclinic.org/health/diseases/23228-refeeding-syndrome
● Within Health – Examining the anorexia death rate
https://withinhealth.com/learn/articles/examining-the-anorexia-death-rate
● National Library of Medicine – Chronic Starvation Secondary to Anorexia
Nervosa is Associated with an Adaptive Suppression of Resting Energy
Expenditure https://pmc.ncbi.nlm.nih.gov/articles/PMC3942230/
● American Heart Association – How eating disorders can damage the heart
https://www.heart.org/en/news/2024/02/26/how-eating-disorders-can-damage
-the-heart
● PubMed Central – Adipose tissue distribution after weight restoration and
weight maintenance in women with anorexia nervosa
https://pmc.ncbi.nlm.nih.gov/articles/PMC2762154/
● Royal Osteoporosis Society – Anorexia and Osteoporosis
https://theros.org.uk/information-and-support/osteoporosis/causes/anorexia/